• 解放軍第101 醫(yī)院骨科（江蘇無錫，214044）;

目的?比較手術(shù)與非手術(shù)治療老年肱骨近端三、四部分骨折的療效。?方法?2009年1月－2011年1 月，收治35例肱骨近端三、四部分骨折老年患者。其中20例行切開復(fù)位、鎖定鋼板內(nèi)固定治療（手術(shù)組），15例行閉合復(fù)位、夾板或石膏外固定（非手術(shù)組）。兩組患者性別、年齡、病因、骨折分型及病程等一般資料比較，差異均無統(tǒng)計學(xué)意義（P  gt; 0.05），具有可比性。兩組治療后均行正規(guī)功能鍛煉。?結(jié)果?手術(shù)組患者術(shù)后切口均Ⅰ期愈合。兩組患者均獲隨訪，隨訪時間12～20個月，平均16個月。X線片檢查示，除手術(shù)組1例（5.0%）骨折不愈合，其余患者骨折均愈合。手術(shù)組2例（10.0%）、非手術(shù)組1例（6.7%）發(fā)生內(nèi)翻畸形，手術(shù)組1例（5.0%）、非手術(shù)組1例（6.7%）發(fā)生肱骨頭缺血性壞死。兩組以上并發(fā)癥發(fā)生率比較，差異均無統(tǒng)計學(xué)意義（P  gt; 0.05）。末次隨訪時，手術(shù)組與非手術(shù)組肩關(guān)節(jié)功能Constant-Murley評分分別為（66.8 ± 11.8）分及（64.7 ± 9.9）分，比較差異無統(tǒng)計學(xué)意義（t=0.59，P=0.47）。?結(jié)論?手術(shù)與非手術(shù)治療老年肱骨近端三、四部分骨折療效相似，對手術(shù)風(fēng)險高、日?；顒右蟮突蚓芙^手術(shù)治療的老年患者可選擇非手術(shù)治 療。

引用本文： 樊嶸,馮彥華,王詩波,駱宇春. 手術(shù)與非手術(shù)治療老年肱骨近端復(fù)雜骨折療效比較. 中國修復(fù)重建外科雜志, 2012, 26(9): 1029-1032. doi: 復(fù)制

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1. 廖春來, 王培信, 謝逸波, 等. 老年骨質(zhì)疏松性肱骨近端粉碎性骨折手術(shù)方式的選擇. 中國修復(fù)重建外科雜志, 2009, 23(12): 1443-1446.
2. Barrett JA, Baron JA, Karagas MR, et al. Fracture risk in the U. S. Medicare population. J Clin Epidemiol, 1999, 52(3): 243-249.
3. Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg (Br), 2007, 89(9): 1206-1209.
4. van den Broek CM, van den Besselaar M, Coenen JM, et al. Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment. Arch Orthop Trauma Surg, 2007, 127(6): 459-463.
5. Kollig E, Kutscha-Lissberg F, Roetman B, et al. Complex fractures of the humeral head: which long-term results can be expected? Zentralbl Chir, 2003, 128(2): 111-118.
6. Neer CS 2nd. Displaced proximal humeral fractures. Ⅱ. Treatment of three-part and four-part displacement. J Bone Joint Surg (Am), 1970, 52(6): 1090-1103.
7. Rees J, Hicks J, Ribbans W. Assessment and management of three- and four-part proximal humeral fractures. Clin Orthop Relat Res, 1998, (353): 18-29.
8. Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury, 1998, 29(5): 349-352.
9. Hanson B, Neidenbach P, de Boer P, et al. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg, 2009, 18(4): 612-621.
10. Yüksel HY, Yimaz S, Ak?ahin E, et al. The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients. J Orthop Trauma, 2011, 25(10): 588-595.
11. Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observationalstudy. J Bone Joint Surg (Am), 2009, 91(6): 1320-1328.
12. Hirschmann MT, Quarz V, Audigé L, et al. Internal fixation of unstable proximal humerus fractures with an anatomically preshaped interlocking plate: a clinical and radiologic evaluation. J Trauma, 2007, 63(6): 1314-1323.
13. Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
14. Iyengar JJ, Devcic Z, Sproul RC, et al. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma, 2011, 25(10): 612-617.
15. Kontakis G, Koutras C, Tosounidis T, et al. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg (Br), 2008, 90(11): 1407-1413.
16. Kralinger F, Unger S, Wambacher M, et al. The medial periosteal hinge, a key structure in fractures of the proximal humerus: a biomechanical cadaver study of its mechanical properties. J Bone Joint Surg (Br), 2008, 91(7): 973-976.
  1. 1. 廖春來, 王培信, 謝逸波, 等. 老年骨質(zhì)疏松性肱骨近端粉碎性骨折手術(shù)方式的選擇. 中國修復(fù)重建外科雜志, 2009, 23(12): 1443-1446.
  2. 2. Barrett JA, Baron JA, Karagas MR, et al. Fracture risk in the U. S. Medicare population. J Clin Epidemiol, 1999, 52(3): 243-249.
  3. 3. Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg (Br), 2007, 89(9): 1206-1209.
  4. 4. van den Broek CM, van den Besselaar M, Coenen JM, et al. Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment. Arch Orthop Trauma Surg, 2007, 127(6): 459-463.
  5. 5. Kollig E, Kutscha-Lissberg F, Roetman B, et al. Complex fractures of the humeral head: which long-term results can be expected? Zentralbl Chir, 2003, 128(2): 111-118.
  6. 6. Neer CS 2nd. Displaced proximal humeral fractures. Ⅱ. Treatment of three-part and four-part displacement. J Bone Joint Surg (Am), 1970, 52(6): 1090-1103.
  7. 7. Rees J, Hicks J, Ribbans W. Assessment and management of three- and four-part proximal humeral fractures. Clin Orthop Relat Res, 1998, (353): 18-29.
  8. 8. Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury, 1998, 29(5): 349-352.
  9. 9. Hanson B, Neidenbach P, de Boer P, et al. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg, 2009, 18(4): 612-621.
  10. 10. Yüksel HY, Yimaz S, Ak?ahin E, et al. The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients. J Orthop Trauma, 2011, 25(10): 588-595.
  11. 11. Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observationalstudy. J Bone Joint Surg (Am), 2009, 91(6): 1320-1328.
  12. 12. Hirschmann MT, Quarz V, Audigé L, et al. Internal fixation of unstable proximal humerus fractures with an anatomically preshaped interlocking plate: a clinical and radiologic evaluation. J Trauma, 2007, 63(6): 1314-1323.
  13. 13. Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
  14. 14. Iyengar JJ, Devcic Z, Sproul RC, et al. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma, 2011, 25(10): 612-617.
  15. 15. Kontakis G, Koutras C, Tosounidis T, et al. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg (Br), 2008, 90(11): 1407-1413.
  16. 16. Kralinger F, Unger S, Wambacher M, et al. The medial periosteal hinge, a key structure in fractures of the proximal humerus: a biomechanical cadaver study of its mechanical properties. J Bone Joint Surg (Br), 2008, 91(7): 973-976.